Application for transfer of permit to transport prescribed industrial waste
Environment Protection Act 1970
Form F1010.1April 2018
*This replaces form F1008 issued December 2017
Read Permit to transport prescribed industrial waste (EPA Publication IWRG811)and Vehicle guidance: Non-tanker vehicles/trailers (EPA Publication IWRG814) or Vehicle guidance: Tanker/tanker trailer (EPA Publication IWRG816) before completing this application.
Please email complete application as a PDF or Word document to the Permitting team at
Note: EPA will transfer, or refuse to transfer a permit within 21 days after receiving a complete application and the relevant fee, or 21 days after receiving any additional information requested by us, whichever is the later.
PART 1: Applicant detailsApplicant name (new registered vehicle owner, to whom the permit is to be transferred)
ABN(if applicable) / ACN (if applicable)
Full name of person authorised to make statements on behalf of the applicant
Phone / Mobile
Registered address (as per ASIC register)
Physical address (operating business in VIC)
Postal address (for correspondence)
Garage location (regular garaging address for vehicle)
Do you wish to apply to change the waste permitted types in the current vehicle permit? / Yes
If 'yes' you will need to complete the form 'Application for amendment of permit to transport prescribed industrial waste' and send both this transfer form and the amendment form to us.
No
PART 2: Relevant offence declaration (to be completed by all applicants, including corporations)
Has the vehicle permit applicant (being the new vehicle owner, to whom the permit is to be transferred) been found guilty of a ‘relevant offence’ (as defined in Section 20C of the Environment Protection Act) in the past 10 years?
Yes
If yes, please attach a statutory declaration to this permit application, setting out the specific circumstances and why those circumstances should not prevent this application from being approved.
No
Relevant offences are defined in Section 20C of the EP Act. They include any indictable offences and certain summary offences. Relevant offences are considered by EPA in determining whether an applicant is a fit and proper person to hold a permit. Please refer to the guideline Permit to transport prescribed industrial waste(EPA Publication IWRG811) for more information.
PART 3: Corporation relevant offence declaration (to be completed only if the applicant is a corporation)
If the applicant is a corporation, has any director or person concerned in the management of the corporation been found guilty of a ‘relevant offence’ as defined in Section 20C of the Environment Protection Act in the past 10 years?
Yes
If yes, please attach a statutory declaration from that person (or each of those persons) to this permit application, setting out the specific circumstances and why those circumstances should not prevent this application from being approved.
No
Relevant offences are defined in Section 20C of the EP Act. They include any indictable offences and certain summary offences. Relevant offences are considered by EPA in determining whether persons are fit and proper to be involved in a corporation holding a permit. Please refer to the guideline Permit to transport prescribed industrial waste(EPA Publication IWRG811) for more information.
PART 4: Existing permit and vehicle details
Permit number / Registration number
Interstate registered vehicle / Yes
If yes, attach a copy of the vehicle registration certificate
No
Full name of existing permit holder
Business address of existing permit holder
Name and address of person authorised to make statements of behalf of the existing permit holder
PART 5: Declaration of applicant – your application will not be accepted unless the declaration is completed and signed
Environmental Protection (Industrial Waste Resource) Regulations 2009
I hereby declare that I have made all necessary enquiries and the information provided in this application (including any attachments) is true and correct. I understand that it is an offence to intentionally or negligently provide incorrect or misleading information to the Environment Protection Authority or to conceal information from the Authority.
I also declare that the vehicle, detailed in Part 4, is fit for the purpose of transporting the prescribed industrial waste specified in the permit and conforms to the relevant vehicle requirements set out in Vehicle guidance: Non-tanker vehicles/trailers (EPA Publication IWRG814) or Vehicle guidance: Tanker/tanker trailer (EPA Publication IWRG816) and Permit to transport prescribed industrial waste (EPA Publication IWRG811).
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Family name / Given name/sPosition
(applicable to companies)
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Signature (1) / Date / / /Signature (2) / Date / / /
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A digital copy of the applicant’s signature is acceptable, in lieu of a wet signature.If a company, a person of authority must complete.
Second signature only required if the applicant is a partnership.
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The personal information on this form and any correspondence, notice or other document issued after processing of this information will be stored and used by EPA for the purpose of administering the Environment Protection Act 1970 and Environment Protection (Industrial Waste Resource) Regulations 2009. You may access this information by contacting the EPA Privacy Information Officer. This information may be disclosed to another Government organisation, tribunal or court, where required for administering or enforcing the above Act and Regulations or any other relevant laws.
PART 6: Checklist – to be completed by the applicantIndustrial Waste Resource Guideline IWRG811 (applicable to all vehicle types), IWRG814 (applicable to non-tanker vehicles/trailers) and IWRG816 (applicable to tanker/tanker trailer) read and understood.
Relevant offence declaration completed (Parts 2 and 3). Documentation attached (if you selected yes).
Copy of vehicle registration certificate attached (for vehicles registered with an interstate authority OR with VicRoads within the last 4 weeks).
Declaration (Part 5) read and signed.
Appropriate insurance policy is maintained for the vehicle as described in EPA Guideline IWRG811.
Do not send any fees with this application – EPA will advise you of the correct fee to be paid once assessment of the application is complete.
Complete and enclose form Application for amendment of permit to transport prescribed industrial waste if you wish to vary the permitted waste types.
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